Search

The current paper presents an examination of the emerging role of deep learning-based simulation software in enhancing preprocedural planning for intracranial aneurysm treatment using flow diverters. Intracranial aneurysms pose significant risk due to their potential rupture leading to life-threatening subarachnoid hemorrhage. Innovative endovascular treatment options like flow diverters, which redirect blood flow and promote healing, are gaining attention. The role of simulation software in optimizing these procedures is becoming increasingly crucial.

Introduction: At the time of diagnosis, most patients with lung cancer are in an inoperable stage, with distant metastases. Most often, these patients have metastases to the brain, adrenal glands, liver, or bones. This article presents the case of a patient with non-small-cell lung cancer (NSCLC) metastases in the abdominal wall.

Introduction: Enchondromas are benign tumors originating in the cartilaginous tissue of the hyaline gristle, rarely located in the chest wall. They sometimes undergo a sarcomatous transformation, becoming secondary chondrosarcomas.

Introduction: Acute abdominal pain persists in defying modern diagnostic procedures. Inflammatory response variables in urine and blood tests can help rule out other disorders and support a clinical diagnosis of acute appendicitis (AA), but there is no specific blood test that can diagnose AA. In order to address this, our study sought to establish the value of (NLR) as a prognostic and severity predictor in patients with AA.

Introduction: Our study investigated the importance of inflammation markers – ratio of platelets and lymphocytes (PLR), ratio of neutrophils and lymphocytes (NLR) and ratio of lymphocytes and monocytes (LMR) – as predictive markers in the occurrence of fistula or stenosis in patients diagnosed with gastric adenocarcinoma who underwent gastric resections.

Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition.

Introduction: There are many authors who have devoted their time and expertise to find creative ways for an ideal suture of bronchial stump. Despite their efforts, the bronchial fistula rate reported in the specialty literature remains high, between 2--16%, depending on the author. There are two methods for closing bronchial stumps: manual and mechanical suture. The aim of this study was to experiment a new technique for closing bronchial stumps after lung resections. Material and method: In order to carry out this study we used 15 common rabbits. We performed left inferior lobectomy in these rabbits. These rabbits were divided into three groups according to the methods used to close the bronchial stump. We used three methods for closing the bronchial stump: simple running suture, suture of the bronchial stump using two vicryl mesh patches and suture of the bronchial stump using two heterologous bovine pericardial patches. Results: We did not notice any cases of bronchial stump fistula. The most important changes that appear during the bronchial stump healing are: inflammatory response, angiogenesis, hyperplasia of the smooth muscle fibres, migration of fibroblasts and fibrogenesis. Conclusions: Healing signs appeared on all examined samples, but they were more intensive in the group where we used the heterologous bovine pericardium for closing the bronchial stump. Some further studies are necessary to examine the effectiveness of the use of heterologous bovine pericardium to protect the bronho-anastomosis. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to analyze in parallel the 6th and the newest 7th AJJCC/UICC (American Joint Committee on Cancer/ International Union Against Cancer) staging system in order to highlight changes brought about the new staging system. Methods: We analyzed data obtained retrospectively from 134 hospitalized patients diagnosed with gastric carcinomas, who underwent surgery at the Surgery Clinic of the Emergency County Hospital of Tîrgu Mureş, Romania between 2008-2010. The data have been obtained from histopathology reports, and the analyzed parameters were the following: age, gender and pTNM staging. For all cases included in the study restaging was performed according to the 7th AJJCC/UICC staging system. For statistical analysis we used GraphPad InStat software. Results: 71.66% of cases were adenocarcinomas, 7.46% mucinous adenocarcinoma, 14.17% signet ring cell carcinoma, and 6.71% undifferentiated carcinoma. The signet ring cell carcinomas predominated before 65 years of age (p=0.003). Compared to the 6th staging system, in the new system, pT2 percentages decreased significantly from 38.8% to 6.71%, and pT4 increases from 11.19% to 55.97% (p<0.0001). The pN3 cases increased from 20.9% to 45.52%, because all cases classified as pN2 in the old staging system, become pN3 in the new system. Some of pN1 cases turned into pN2 in the new system (p=0.004). The stage IV cases also decreased from 29.85% to 14.94%, due to regrouping of stage III. Conclusions: There are significant changes between the two staging systems. The new staging system aims to achieve a better postoperative follow-up. [ABSTRACT FROM AUTHOR]

Abdominal trauma is a common diagnosis for patients admitted to the emergency room. Evaluation of the severity of such patients can sometimes be difficult due to rapid hemodynamic changes caused by the activation of inflammatory and anti-inflammatory regulatory mechanisms. To evaluate the prognosis of trauma patients, it is crucial to identify these changes and adapt various treatment strategies. Using the records of the Mures County Emergency Clinical Hospital, 126 patients were included in the present study with traumatic splenic injury admitted over 6 years. Blood parameters such as the neutrophil, lymphocyte, and platelet counts, the neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio (PLR) were determined, and the association between these and the severity of the traumatic injury [quantified as the injury severity score (ISS)] was calculated. We used linear and multiple regression analyses to identify and quantify the relationships. We found statistically significant associations between the ISS and the NLR (P=0.002), with an AUC of 0.816 and a cut-off value of NLR=6.075 (sensitivity=76.7%, specificity=74.3%), and between the ISS and hemoglobin (P<0.0001), hematocrit (P<0.0001), neutrophil count (P<0.0001), lymphocyte count (P=0.0224), and platelet count (P=0.0163). No association was found between the PLR and the severity of trauma. An elevated NLR at admission in trauma patients had significant predictive power for the severity of trauma. Patients with an NLR greater than the cut-off value of 6.075 were more likely to have suffered serious injuries and undergone deterioration., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Vunvulea et al.)

Background: In the case of patients admitted with acute abdomen at the emergency department, interstitial pulmonary pathology (Covid-19 infections) represents a significant operative risk for the patients. The rate of postoperative complications is high with increased morbidity and mortality, a real challenge for the medical staff and surgical/intensive care unit teams. In emergency settings, patients were examined with targeted clinical and paraclinical parameters that assure a fast diagnosis to optimize a rapid medical and surgical treatment. Methods: We conducted a retrospective comparative study that included patients enrolled and diagnosed with an acute surgical abdomen in Surgical Clinic 1 Tg. Mures Emergency County Hospital. Patients were examined and analyzed at the emergency department UPU-SMURD. We included patients admitted over the two years (2019 and 2020) and divided them into two groups. Results: The total number of patients admitted in the UPU-Smurd emergency department Surgical Clinic I over the two years was 1033. There was a significant reduction in total cases diagnosed with the acute surgical abdomen in the pandemic period (p=0.033). The average time from the admission to the surgical procedure was significantly higher in the pandemic period 380Ã+-2 min in comparison with 222+-3 min (p=0.001) and also with an increased average operative time 223+-3 min versus 145+-2 min (p=0.002). Average hospitalization time was higher in the pandemic period 10+-1 (p=0.031) with no significant difference between the groups regarding Intensive Care Unit (ICU) admission (p=0.122). Overall mortality has more than doubled, with 31 cases (19%) in the pandemic and 28 (9%) in the non-pandemic. (p=0.001). Conclusions: The COVID-19 pandemic has played an essential role in treating acute surgical abdomen cases. The high solicitation rate of the emergency department delayed the diagnosis and treatment of severe surgical cases. As the scale of this pandemic is unprecedented, standard protocols with minor changes do not provide adequate results., (Celsius.)

Background: There is no consensus regarding optimal timing or best surgical procedure for refractory renal hyperparathyroidism patients. We aim to compare the results after three types of parathyroidectomies performed for sHPT in a single referral centre., Methods: This study included patients on chronic hemodialysis submitted to three types of parathyroidectomy between 2010 and 2017. The primary outcome measure was relief of the symptoms and normalization of the main biochemical parameters., Results: All symptoms improved significantly after surgery, especially osteoatricular pains. iPth dropped significantly immediately and during the follow up in all 3 groups; on short term, iPth values for group C(tPtx) were significantly lower compared to the other 2 subgroups (p=0.009). Furthermore, 5 patients from group C presented iPth values <12 pg/ml one year post-surgery, though this values tend to improve after. Patients from group B and C developed most often acute postoperative hypocalcemia, and persistent hyperparathyroidism was encountered especially after sPtx(10.3%)., Conclusion: Significant improvement of both symptoms and biochemical parameters was noted in the majority of cases, regardless the parathyroidectomy type. tPtx is frequently followed by chronic hypoparathyroidism and subtotal parathyroidectomy is followed by a higher number of persistent and recurrent sHPT., Key Words: Secondary hyperparathyroidism, Parathyroidectomy, Parathyroid autotransplant.

Background: The incisional hernia continues to be a frequent complication of laparotomies. The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall., Material and Methods: A prospective longitudinal study was performed that included 142 patients. An analysis was performed on the individual data, the level of obesity, intra-surgical variations in intra-abdominal pressure, the intensity of post-surgical pain, the post-surgical complications, and the types of plasties of abdominal wall, simple and with polypropylene mesh., Results: The analysis of studied group showed a general rate of relapse of 16.9%, and within the 4 procedures, 40.74% in the case of simple plasties, of 16.07% after the only plasties, 6.97% after the retro-muscular plasties, and 6.25% after the full substitution of parietal defect. On analysing the collected, hernia relapse was statistically significantly related to the level of obesity, variations in intra-abdominal pressure, post-surgical pain, and the type of procedure performed., Conclusions: Hernia is a frequent complication of laparotomies. Hernia relapse was more frequent in the case of simple plasties. Among the mesh procedures, the onlay plasty showed a higher rate of relapse and post-surgical complications. Hernia relapse was more frequent in the case of variations of intra-abdominal pressure, and with increased post-surgical pain. The use of an echography examination may increase the accuracy of the presence of hernia disease., (Copyright © 2015 Academia Mexicana de Cirugía A.C. All rights reserved.)

Aim: Incisional hernias represent a late onset complication of any type of laparotomy, with a relatively high incidence, and reported in 2% to 11% of all laparotomies., Material and Methods: We performed a prospective longitudinal study that included a total number of 102 patients. The following parameters were monitored: patient history clinical findings, time of hospitalization, laboratory test results, types of surgery. Intra-abdominal pressure variations were measured using a specialized kit., Results: Obesity was present in 69 of the patients (67.64%). Mesh plasty was most frequently used (80.39%). The inset of the mesh was performed in onlay position (40.19%), retromuscular (29.98%) or complete defect substitution (11.76%). The correlation between the type of abdominal wall plasty, variations on the Borg dyspnea scal and likewise the correlation between the VAS (visual analogue scale) pain scale and the abdominal wall plasty procedures proved to be highly statistically significant: p< 0.001. Furthermore, the intra-abdominal pressure varied with the type of abdominoplasty carried out, reviewing the tension free principle. The most important parameter was the intra-abdominal pressure recorded at the end of the abdominoplasty, which showed significant correlations with the tension free plasties (retromuscular mesh and substitution mesh)., Conclusions: The tension free methods, reflected by the intra-abdominal pressure variation, were associated with a lower degree of dyspnea, low postoperative pain and less hospitalization time., Key Words: Borg scale, Incisional hernia, Intra-abdominal pressure, Onlay, Visual analogue scale.